Clinical Research

(CR-018) Impact of fluorescence imaging of bacterial presence, location, and load on wound outcomes: retrospective analysis of 193 wounds from Medicare patients

Co-Author(s):

Introduction: LTC and SNF have a disproportionately high rate of wounds and wound-related infections and their 12-week wound healing rate is 10% lower than the national average, which is already far from ideal at ~30%. Infection and bacterial burden are major contributors to poor outcomes, and their prevention, diagnosis, and treatment should be optimized. Fluorescence (FL) imaging has been of diagnostic value in detecting pathogenic bacterial loads and locations; the present study aimed to determine the impact of this technology on wound outcomes in SNF and LTC facilities. Methods: A systematic retrospective pre/post interventional analysis was performed. 193 randomly selected wounds (pressure injuries, diabetic foot ulcers, and mixed from 113 patients met the inclusion criteria. Two cohorts were obtained, one form a pre-FL imaging period (SoC) (n=89) (Jan 2019- Feb 2020) and another from a post-FL imaging period (n=104) (May 2021- March 2022) Results: Demographic and medical characteristics were homogeneous between the 2 cohorts and most wounds were full-thickness (93%). After integrating FL-imaging into patient care, mean wound healing time shortened: 17.6 to 12.2 weeks (p=0.025; t-test). 
Healed wound percentage within 12 weeks increased by 57% (20.2% to 31.7%) post-integration FL-imaging, healing rate trend seen as early as 8 weeks (51% increase). 
Systemic antibiotics decreased by 29% (48% vs. 33% of patients) and percent of severe infection-related complications (cellulitis, sepsis, osteomyelitis, or wound-associated hospitalization) decreased 5.3-fold (17% vs. 3%). Use of PCR microbiology decreased by 38% after incorporating FL-imaging. Discussion: Integration of point-of-care FL-imaging into a complex wound care practice dramatically improved outcomes, including a reduction in infection-related complications. These results are likely attributable to imaging-enabled early detection and immediate intervention (hygiene, debridement, topical antimicrobials) against high bacterial loads and covert infections. 
Based on these findings, optimizing care by incorporating this technology into LTCs and SNFs would have a significant impact on healthcare expenditure by increasing ulcer-free days and reducing hospitalizations, systemic antibiotic use, amputations, and wound sampling expenses. Trademarked Items: Moleculight References: